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NO.5 For the manegement of chronic nonspecific low back pain
         
(CLBP)

  

 Chronic low back pain is defined as the duration of an episode of low back pain persisting for 12 weeks or more.

This is the evidence-based guideline named European guidelines for low back pain. (Euro Spine J 2006 15: S131-S300) Let me introduce their recommendations.
  
  Recommend
Supervised exercise therapy as a first-line treatment.
Advocate the use of exercise programs that do not require expensive machines and the use of cognitive-behavioral approach, group exercise.

Brief educational interventions, which can be provided by a physiotherapist or physiotherapist and a physician, and which encourage a return to normal activities, to reduce sickness absence and disability associated with CLBP.

Cognitive-behavioral treatment.
Multidisciplinary biopsychological rehabilitation with functional restoration.

  Consider
A short course of spinal manipulation/ mobilization.
 Back-schools where information given is consistent with evidence-based recommendations for short-term (<6 weeks) pain relief and improvements in functional status.

Prescribe medication
  The use of noradrenergic or noradrenergic-serotonergic antidepressants without renal disease, glaucoma, pregnancy, chronic obstructive pulmonary disease and cardiac failure.

  The use of muscle relaxants (benzodiazepines); caution due to their side effects.

  The use of NSAIDs.

  The use of weak opioids (e.g. tramadol) in patients with nonspecific chronic LBP who do not respond to other treatment modalities. Due to addiction, slow-release opioids are preferable to immediate-release opioids, and should be given regularly (around the clock) rather than as needed.

  The use of capsicum pain plasters for short-term symptomatic pain relief


Neuroflexotherapy
Percutaneous electrical nerve stimulation (PENS)
They strongly recommend that only carefully selected patients with severe pain (and with maximum 2 affected levels) should be considered for the fusion surgery.


  Do not recommend
 Transcutaneous electrical nerve stimulation (TENS).
The specific type of exercise to be undertaken
     Strengthening/ muscle conditioning, aerobic, McKenzie,
     Flexion exercise( may be best determined by the exercise-preferences of both the patient and therapist.)
 Back schools as a long-term effects (>12months)

The use of intradiscal injections
The injection of sclerpsants (prolotherapy)
Transcutaneous electrical nerve stimulation

   Cannot recommend
       Interferential therapy
       Laser therapy
       Lumber supports
       Shortwave diathermy
       Therapeutic ultrasound
       Thermotherapy/ heat
       Lumber traction
       Massage
       The use of gabapentin
       Acupuncture
       The use of epidural corticosteroids
       The use of intraarticular injections of steroids or facet nerve blocks
       The use of Botulinum toxin
       The use of sacroiliac joint injection with corticosteroids
       The use of trigger point injections
       Radiofrequency facet denervation.
       The use of intradiscal radiofrequency, electrothermal coagulation or radiofrequency denervation of the rami communicans
       The use of radiofrequency lesioning
       The use of spinal cord stimulation
       Fusion surgery for CLBP unless 2 yearsof all other recommended conservative treatments have failed and combined programs of cognitive intervention and exercises are not available in the given geographical area.

Please come on my clinic to consult your low back pain.

  

 

 
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平成29年9月の休診日

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東京都目黒区下目黒6丁目14-17

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